Biomechanical Properties of Strictures in Crohn's Disease: Can Dynamic Contrast-Enhanced Ultrasonography and Magnetic Resonance Enterography Predict Stiffness?

Strictures and abdominal pain often complicate Crohn's disease (CD). The primary aim was to explore whether parameters obtained by preoperative contrast-enhanced (CE) ultrasonography (US) and dynamic CE MR Enterography (DCE-MRE) of strictures associates with biomechanical properties. CD patients undergoing elective small intestinal surgery were preoperatively examined with DCE-MRE and CEUS. The excised intestine was distended utilizing a pressure bag. Luminal and outer bowel wall cross-sectional areas were measured with US. The circumferential stricture stiffness (Young's modulus E) was computed. Stiffness was associated with the initial slope of enhancement on DCE-MRE (ρ = 0.63, p = 0.007), reflecting active disease, but lacked association with CEUS parameters. For structural imaging parameters, inflammation and stricture stiffness were associated with prestenotic dilatation on US (τb = 0.43, p = 0.02) but not with MRE (τb = 0.01, p = 1.0). Strictures identified by US were stiffer, 16.8 (14.0-20.1) kPa, than those graded as no or uncertain strictures, 12.6 (10.5-15.1) kPa, p = 0.02. MRE global score (activity) was associated with E (ρ = 0.55, p = 0.018). Elastography did not correlate with circumferential stiffness. We conclude that increasing activity defined by the initial slope of enhancement on DCE-MRE and MRE global score were associated with stricture stiffness. Prestenotic dilatation on US could be a potential biomarker of CD small intestinal stricture stiffness.

Animal models of pancreatitis: can it be translated to human pain study?

Chronic pancreatitis affects many individuals around the world, and the study of the underlying mechanisms leading to better treatment possibilities are important tasks. Therefore, animal models are needed to illustrate the basic study of pancreatitis. Recently, animal models of acute and chronic pancreatitis have been thoroughly reviewed, but few reviews address the important aspect on the translation of animal studies to human studies. It is well known that pancreatitis is associated with epigastric pain, but the understanding regarding to mechanisms and appropriate treatment of this pain is still unclear. Using animal models to study pancreatitis associated visceral pain is difficult, however, these types of models are a unique way to reveal the mechanisms behind pancreatitis associated visceral pain. In this review, the animal models of acute, chronic and un-common pancreatitis are briefly outlined and animal models related to pancreatitis associated visceral pain are also addressed.

The impact of age on incremental elastic modulus and incremental compliance of pig hepatic portal vein for liver xenotransplantation.

BACKGROUND: Pigs are currently considered the most likely source of organs for human xenotransplantation because of anatomical and physiological similarities to humans, and the relative ease to be bred in large numbers. Along with the fast development of the genetic engineering and organ transplant immunity medical science, the research of liver xenotransplantation suffers the very big valuing in recent years. Whether the livers from different species after transplanting can perform the normal function, depends on the function regeneration and lucid rates of hepatic portal vein. The objective of this study was to investigate the age effect on biomechanical properties of pig hepatic portal vein to pave the way for seeking a reliable biomaterial for future pig-to-human liver xenotransplantation. METHODS: The biomechanical remodelling of the hepatic portal vein of pigs for 1,2,3,4,5 and 6 months (n = 6 per month) were measured in this study. The blood vessel was given periodic permanent loading and unloading, and repeated force-deformation data were obtained. The incremental modulus (Einc), the longitudinal incremental modulus (Ep), the circumferential incremental modulus (Ev), incremental compliance (C) and wall thickness were calculated based on the recorded pressure-diameter curves from experimental data. RESULTS: The incremental modulus, pressure strain modulus and the volume modulus of the pig hepatic portal vein increases with the age increased (P < 0.01), while the compliance decreased with the increasing of the age (P < 0.01). CONCLUSIONS: Our present study suggests that the biomechanical properties of the pig hepatic portal vein are age dependent, the pig hepatic portal vein with biomechanical properties that match those of human hepatic portal vein should be chosen for liver xenotransplantation.

Gastrointestinal tract modelling in health and disease.

The gastrointestinal (GI) tract is the system of organs within multi-cellular animals that takes in food, digests it to extract energy and nutrients, and expels the remaining waste. The various patterns of GI tract function are generated by the integrated behaviour of multiple tissues and cell types. A thorough study of the GI tract requires understanding of the interactions between cells, tissues and gastrointestinal organs in health and disease. This depends on knowledge, not only of numerous cellular ionic current mechanisms and signal transduction pathways, but also of large scale GI tissue structures and the special distribution of the nervous network. A unique way of coping with this explosion in complexity is mathematical and computational modelling; providing a computational framework for the multilevel modelling and simulation of the human gastrointestinal anatomy and physiology. The aim of this review is to describe the current status of biomechanical modelling work of the GI tract in humans and animals, which can be further used to integrate the physiological, anatomical and medical knowledge of the GI system. Such modelling will aid research and ensure that medical professionals benefit, through the provision of relevant and precise information about the patient's condition and GI remodelling in animal disease models. It will also improve the accuracy and efficiency of medical procedures, which could result in reduced cost for diagnosis and treatment.

Age and gender related changes in biomechanical properties of healthy human costal cartilage.

BACKGROUND AND AIMS: For repairing the ear malformation, it is recommended in China to use the over than 10-years-old rib cartilage. However, according to our clinical experience, a better post-operation effect can be found using about the 7-years-old cartilage for the operation. To shape a harvested costal cartilage and to perform it on the transplant site depend on the mechanical properties of the costal cartilage. Hence, the aim of this study is to investigate the age and gender-related biomechanical properties of the human costal cartilage. METHODS: Human costal cartilages were harvested from 25 female and 45 male donors of 5-25 years old after auricular reconstructive surgery. The specimens were divided into six groups: children (5-10 years), adolescent (11-17 years) and adult (18-25 years), respectively, in males and females. Tensile strength, stress-strain relationship, stress relaxation and creep were tested by using a material testing machine. FINDINGS: The biomechanical properties of costal cartilage are donor age and gender related. The children group has the highest tensile strengths (P<0.01) in both male and female groups. The male group relaxed and crept more than that of the female group in all three age groups (P<0.01). INTERPRETATION: These findings provide a further support for the potential age acting on the human costal cartilage. The adolescent has the lowest strength, this could be a reason that compared to using the children costal cartilage, the bigger distortion happened after using the adolescent costal cartilage in the auricular reconstruction operation.

Biomechanical characteristics investigation on long-term free graft with expanded porcine skin.

BACKGROUND: Free skin graft has to be used when the large area skin are burned. The objective of this study is to quantify the influence of free graft and expansion on the skin biomechanical remodeling. METHOD: Four white pigs (weighing from 17 kg to 23 kg) were used. Two 180 ml rectangle expanders were aseptically placed beneath the skin on the back of each pig. Four normal skin flaps and four expanded skin flaps were incised from the foreside back of each pig. Two normal skin flaps and two expanded skin flaps were then grafted to rearward back of the pig. Stress-strain relationship, stress relaxation and creep characters in normal skin: N(n=8), expanded skin without graft: E(n=8), normal skin with free graft after three months: NG(n=8) and expanded skin with free graft after three months: EG(n=8) were measured by using Instron material testing machine. FINDINGS: The strains at 3.5 MPa stress (mean (SD)) are 0.4436(0.1760), 0.4851(0.1401), 0.7750(0.1984) and 0.5854(0.0655) respectively in N, E, NG and EG groups. The maximum relaxations (mean (SD)) are 0.6324(0.0169), 0.6279(0.0401), 0.5630(0.0170) and 0.6057(0.0883) in N, E, NG and EG groups, respectively. The maximum creeps (mean (SD)) are 1.0876(0.0086), 1.1037(0.0116), 1.1948(0.0394) and 1.1328(0.0223) in N, E, NG and EG groups. INTERPRETATION: The biomechanical characteristics of free graft with expanded skin after three months have no significant difference with the normal skin, expansion skin and free graft with normal skin after three months (P>0.05). The free graft and expansion have no significant influence on the skin biomechanical remodeling.

Morphologic and biomechanical changes of rat oesophagus in experimental diabetes.

AIM: To study morphologic and biomechanical changes of oesophagus in diabetes rats. METHODS: Diabetes was induced by a single injection of streptozotocin (STZ). The type of diabetes mellitus induced by parenteral STZ administration in rats was insulin-dependent (type I). The samples were excised and studied in vitro using a self-developed biomaterial test machine. RESULTS: The body mass was decreased after 4 d with STZ treatment. The length of esophagus shortened after 4, 7, 14 d. The opening angle increased after 14 d. The shear, longitudinal and circumferential stiffness were obviously raised after 28 d of STZ treatment. CONCLUSION: The changes of passive biomechanical properties reflect intra-structural alteration of tissue to a certain extent. This alteration will lead to some dysfunction of movement. For example, tension of esophageal wall will change due to some obstructive disease.

Collagen fiber angle in the submucosa of small intestine and its application in Gastroenterology.

AIM: To propose a simple and effective method suitable for analyzing the angle and distribution of 2-dimensional collagen fiber in larger sample of small intestine and to investigate the relationship between the angles of collagen fiber and the pressure it undergoes. METHODS: A kind of 2-dimensional visible quantitative analyzing technique was described. Digital image-processing method was utilized to determine the angle of collagen fiber in parenchyma according to the changes of area analyzed and further to investigate quantitatively the distribution of collagen fiber. A series of intestinal slice's images preprocessed by polarized light were obtained with electron microscope, and they were processed to unify each pixel. The approximate angles between collagen fibers were obtained via analyzing the images and their corresponding polarized light. The relationship between the angles of collagen fiber and the pressure it undergoes were statistically summarized. RESULTS: The angle of collagen fiber in intestinal tissue was obtained with the quantitative analyzing method of calculating the ratio of different pixels. For the same slice, with polarized light angle's variation, the corresponding ratio of different pixels was also changed; for slices under different pressures, the biggest ratio of collagen fiber area was changed either. CONCLUSION: This study suggests that the application of stress on the intestinal tissue will change the angle and content of collagen fiber. The method of calculating ratios of different pixel values to estimate collagen fiber angle was practical and reliable. The quantitative analysis used in the present study allows a larger area of soft tissue to be analyzed with relatively low cost and simple equipment.